Description

Myelin oligodendrocyte glycoprotein antibody-associated disease, also known as MOGAD, is a rare inflammatory disease that affects the central nervous system. In MOGAD , the immune system attacks the fatty substance that protects nerve fibers of the optic nerves, the brain and the spinal cord.

The symptoms of MOGAD may include loss of vision, muscle weakness, numbness or paralysis, confusion, seizures, and headaches. These symptoms can sometimes be confused with other diseases such as multiple sclerosis.

There is No cure for MOGAD . However, there are treatments to help speed recovery from attacks, manage symptoms and reduce the likelihood of return of the symptoms.

Symptoms

MOGAD cause painful swelling, known as inflammation. The symptoms are caused by the attacks of the:

  • Inflammation of the optic nerve. Called optic neuritis, this condition can lead to loss of vision in one or both eyes, and eye pain that is worse with movement of the eyes. Optic neuritis in children may be confused with a headache.
  • Inflammation of the spinal cord. Called transverse myelitis, this condition can lead to arm or the leg, weakness, muscle stiffness or paralysis. It can also cause the loss of the senses and the changes in the bowel, bladder or sexual function.
  • Inflammation of the brain and the spinal cord. Called acute disseminated encephalomyelitis, also known as ADEM, this condition can lead to vision loss, weakness, walking instability and confusion. ADEM is more common in children with MOGAD .

Other symptoms of MOGAD may include:

  • Seizures.
  • Headaches.
  • Fever.

Course of the disease

Some people who have MOGAD only the experience of an attack of symptoms. This is called a single-phase MOGAD and is slightly more common. However, some people experience multiple attacks, called recurrent MOGAD . The attacks usually develop over days and can be severe and debilitating. Disability generally gets worse with each attack. The attack of the recovery may take weeks to months.

When to see a doctor

Consult a doctor or other health care professional if you experience any of the symptoms mentioned above, for unknown reasons.

Causes

The cause of MOGAD is not known. It is an autoimmune disorder in which the body's immune system attacks its own tissues. In people with MOGAD , the immune system destroys the fatty substance called myelin. Myelin that coats and protects nerve fibers in the optic nerve, brain, and spinal cord.

The brain sends messages between nerve fibers that help tell parts of the body what to do. When the myelin is damaged and the nerve fibers are exposed to, the messages may be slowed or blocked. This means that the parts of the body not working properly.

MOGAD is often misdiagnosed as another disease that attacks the myelin and cause similar symptoms. It can be confused with multiple sclerosis, known as the LADY, OR can be confused with a disease called neuromyelitis optica spectrum disorder, also known as NMOSD.

MOGAD is different from MS and NMOSD because the first attack of MOGAD is usually the most severe, but people with the disease can have a full recovery. MOGAD is also diagnosed in a different way, using the results of magnetic resonance imaging and blood tests. People with MS and NMOSD typically have multiple attacks, while about half of people with MOGAD only have an attack.

Risk factors

These factors can increase your risk of developing MOGAD :

  • Age. Children and young adults are slightly more likely to develop MOGAD .
  • Recent infection or vaccination. MOGAD may develop after an infectious disease or vaccination, such as the SARS-CoV-2 .

Complications

MOGAD complications are caused by the attacks on the fatty substance that protects nerve fibers of the optic nerves, the brain and the spinal cord. The first attack is usually the worst of cases, but each attack can cause more damage. Some possible complications may include:

  • Permanent paralysis in the arms and legs.
  • Long-term bladder and bowel difficulties.
  • Blindness in one or both eyes.
  • Problems with language, memory and thought.

Some MOGAD treatments can also cause complications. The long-term use of certain medications can result in:

  • Infection.
  • Lymphoma or cancer of the skin.
  • Slowed growth in children.
  • Headaches.
  • The renal failure.

Your care team will work with you to decide which treatment options are best, and how long you should continue with them.

Diagnosis

A professional of the health profiles of the symptoms you have and may do a physical exam to look for any sign of MOGAD .

MOGAD is usually diagnosed after that two things have been confirmed. Health professionals confirm that the symptoms were caused by a typical type attack, such as optic neuritis, transverse myelitis or acute disseminated encephalomyelitis (ADEM). MOGAD also be diagnosed after the MOG -antibody found in the blood or in cerebrospinal fluid.

These two things can be confirmed by a couple of procedures, including:

  • MOGantibody testing with a cell-based assay. This test was seen in cells with MOG in your area to see if the MOG -antibody is present in the blood. This test is considered the gold standard for the analysis of MOGAD , but there is potential for false positives. Caution is necessary if the symptoms are not typical and are similar to those of other diseases, such as multiple sclerosis.
  • Spinal tap. Also called a lumbar puncture, this procedure produces a small sample of cerebrospinal fluid for testing. In this example it can show if there is an elevated white blood cell count. This causes swelling and is common in MOGAD . A lumbar puncture can also find a type of protein in the cerebrospinal fluid called oligoclonal bands. These bands are more common in multiple sclerosis and may help you to make a distinction between the two diseases.
  • Imaging tests. You may need an mri of the brain, spinal cord and optic nerve. These pictures can show irregular spots in the brain and spinal cord, called lesions, and inflammation of the optic nerve.
  • Examination of the eyes. An examination of the eyes, called optical coherence tomography, can help to diagnose MOGAD . This test shows the layers of the part of the eye called the retina. During episodes of optic neuritis, the retina is often thicker than usual. After these episodes, the damage to the nerve cells in the retina causes the retina to lose weight.

The MOG antibody test is not always accurate. Sometimes the healthy people or people with other diseases can have MOG antibodies at lower levels. Your health care team uses the results of the test to make sure that nothing else is the cause of your symptoms.

Treatment

There is No cure for the MOGAD . The treatment typically focuses on speeding recovery from attacks, the management of the symptoms and the reduction of relapses. In the meeting with your health care team to come up with a treatment plan that suits your needs.

The treatments for the attacks

The attacks of MOGAD usually are serious and must be treated immediately for the most complete recovery. Treatment options may include:

  • Corticosteroids. Corticosteroids are medicines used for reducing inflammation of the nerve and quickly reverse MOGAD symptoms. Is given in high doses and can be taken by mouth or given through an INTRAVENOUS injection . Side effects may include trouble sleeping, increased blood pressure and blood glucose levels, mood changes and fluid retention.
  • The Plasma exchange. This procedure consists in the removal of the liquid portion of blood, called plasma, and separates it from your blood cells. This process eliminates the MOG antibodies in your blood. The cells of the blood is mixed with a protein solution and put back into your body. Plasma exchange can be used if your symptoms are new, severe, or have not responded to corticosteroids.
  • IVimmune globulin. Also known as intravenous immunoglobulin, this treatment uses antibodies from the plasma of a donor to treat MOGAD . IVIG helps to neutralize the MOG antibodies and reduce inflammation. Intravenous immunoglobulin may also suppress the immune system to prevent future attacks. It is used most commonly in children.

The treatments for the symptoms

The treatment of the symptoms of MOGAD can help to reduce pain and side effects after the attacks. Treatment options may include:

  • Anti-seizure medications. Seizures may occur in some people with MOGAD . Anti-seizure medications help reduce the number of seizures and may prevent them from returning.
  • Therapies. MOGAD attacks can lead to muscle weakness, stiffness and paralysis. Physical therapy and occupational therapy can be used to help rehabilitate parts of the body that have been damaged during the attacks.
  • Other medications. Additional medications may be used to help with symptoms of MOGAD . The pain, fatigue, bowel and bladder symptoms, and erectile dysfunction can be treated with medications.

Treatments to prevent attacks

From MOGAD is a recently discovered disease, there are no proven treatments to prevent the attacks. However, clinical trials are underway to find treatments.

Treatment to prevent the attacks of MOGAD is normally only used if you experience multiple attacks, known as recurrent MOGAD . The attacks can be prevented by the suppression of the immune system. However, this type of treatment can lead to other diseases, and will only be used if it is necessary. Attack prevention, treatment is usually started after the second attack to try to prevent more from happening. But it can be used if the first attack was so severe that it caused permanent damage.

Treatment options may include:

  • Oral immunosuppressive drugs. Medications such as azathioprine, mycophenolate mofetil, and prednisone can be taken orally. These medicines suppress the immune system stops attacking the myelin and causing damage. However, you can take up to a couple of months to work, so that a relapse may still occur. Oral immunosuppressive drugs can have negative effects on the body. These can include infections, eruptions of the skin and the risk of cancer if used long term.
  • IVmedicines. IV immunoglobulin may be used to prevent attacks, as it suppresses the immune system. Other drugs, such as rituximab and tocilizumab may also be given through an IV to help suppress the immune system. Side effects may include headaches and increased risk of infection.

The type of prevention, treatment, you have affects how much time you need the treatment. Some treatments can have negative effects if used long term. Your health care team can help you decide which is the best treatment for you.

Coping and support

Living with a disease can be difficult. To manage the stress of living with MOGAD , consider these suggestions:

  • Maintain normal daily activities in the best possible way.
  • Stay connected with friends and family.
  • Continue hobbies that you like to and are able to do.
  • Contact a support group, for oneself or for family members.
  • Discuss your feelings and concerns about living with MOGAD with your health care team or a counselor.

Preparing for your appointment

You may be referred to a doctor who specializes in disorders of the brain and the nervous system, called a neurologist.

What you can do

  • Write down your symptoms, including those that do not seem to be related to the reason for your appointment.
  • Make a list of all your medications, vitamins and supplements.
  • Bring any clinical notes, scans, laboratory test results or other information from your other health care professionals to your neurologist.
  • Write down your key medical information, including other conditions.
  • Write down key personal information, including any recent changes or stressors in your life.
  • Write questions to ask their health care team.
  • Have a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Your time with your health care team is limited, so preparing a list of questions can help you make the most of their time together. A list of questions from most important to least important in case time runs out. For MOGAD , some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • What kinds of tests do I need? Does not require special preparation?
  • Is my condition likely temporary or permanent?
  • My condition progress?
  • What treatments are available?
  • I have these other health conditions. How can I best manage them together?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Be prepared to answer questions, such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)